Musculoskeletal Research: The Kappa Delta/OREF Awards

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, April 18th, 2017

This year’s recipients of the prestigious Kappa Delta Sorority and the Orthopaedic Research and Education Foundation (OREF) awards have been announced. The awards shine a light on the complexity of the wrist joint, the gait mechanics of the ankle, personalized medicine for clubfoot, and impact of global arthroplasty implant registries. The awards were presented at the recent annual meeting of the American Academy of Orthopaedic Surgeons (AAOS).

The 2017 Kappa Delta Elizabeth Winston Lanier Award was presented to Scott W. Wolfe, M.D., chief emeritus of hand surgery and attending orthopedic surgeon at the Hospital for Special Surgery (HSS) in New York City, for his research titled "Kinematics of the normal and injured wrist: the importance of the midcarpal joint." The research was co-authored by Joseph J. (Trey) Crisco, III, Ph.D., Henry F. Lippitt professor of orthopaedics and professor of Engineering (Research) at Brown University.

Dr. Wolfe commented to OTW, “The list of prior Kappa Delta award recipients is staggering—a virtual ‘who’s who’ of orthopedic giants who have built the foundations of scientific knowledge upon which all current clinical practice is built. While always a dream of ours, winning the Kappa Delta award seemed unattainable. Receiving this award is a validation of the importance of our work to the greater orthopedic community, to orthopedic science, and most importantly, to our orthopedic patients. More importantly, this award represents an enormous incentive to press on, to think outside of the current boundaries of clinical care and to reach higher, towards innovative solutions to help patients with debilitating wrist arthritis.”

Dr. Crisco told OTW, “The wrist is arguably the most complex joint in the human body, capable of moving in multiple directions and throughout a nearly hemispherical range of motion. Made up of eight oddly-shaped small bones whose motion is coordinated by dozens of surrounding ligaments, wrist motion can be broadly described in terms of microkinematics—that describe the motion of each individual bone—or macrokinematics—that describe the motion of the whole wrist, as the hand moves in relation to the forearm.”

“From the outset of our work together, our goal has been to measure—for the first time ever—the micro- and macrokinematics of the wrist in motion, that is, in live subjects, in three dimensions and during the performance of functional activities. The barriers to this were enormous, and required complex computer algorithms and customized software, as live motion analysis in the upper extremity had never been accomplished. Our pioneering efforts adapted existing computer software that was developed to track and identify high-speed military aircraft as they approached U.S. airspace and combined it with newly developed software that was used to track the beating heart!”

“After tackling the ability to independently identify and measure each carpal bone, we were poised to attempt macrokinematics during functional activities. Using 10 high-speed cameras in the HSS Leon Root motion analysis laboratory, we adapted techniques used in the gait laboratory to the wrist to successfully reach our goal. In 2014, we published the first of several scientific manuscripts that described wrist motion during eight common household, recreational and occupational tasks, including pouring from a pitcher, throwing a baseball, hammering, and throwing a dart. The future of non-invasive motion analysis is even brighter—we are now on the threshold of high-speed analysis of both microkinematics and macrokinematics, simultaneously using state-of-the-art techniques at Brown University’s biplanar radiography laboratory.”

“This has the capability of comparing the uninjured wrist to the surgically reconstructed wrist, and even a wrist replaced with a prosthetic arthroplasty. For the future, we have already applied for funding from the National Institutes of Health to design, build and implant an instrumented total wrist arthroplasty, which has the capability of transmitting live motion and load-transmission data from within the patient’s wrist during normal and sporting activities, with the goal of building more durable solutions to wrist arthritis—a condition that affects an estimated 4.8 million people in the United States alone.”

The 2017 Kappa Delta Young Investigator Award was presented to Robin Queen, Ph.D., F.A.C.S.M., associate professor of biomedical engineering and mechanics at Virginia Tech in Blacksburg, Virginia, and associate professor of orthopedic surgery at Virginia Tech Carilion School of Medicine for her research on the impact of ankle osteoarthritis and total ankle replacement on gait mechanics and balance.

Dr. Queen told OTW, “In order for surgeons to begin to take a more holistic approach to treatment and recovery we as researchers need to provide evidence and justification that will demonstrate the short and long-term benefits to patients. We have to be able to demonstrate to the surgeons that using a more holistic approach to treatment and care that their patients have improved patient reported outcomes and satisfaction as well as improved long-term joint function and mobility.”

“This award is a culmination of a decade of work in a patient population that is understudied and a validation that the work I have been doing is high quality and impactful. The recognition has given me a renewed sense of purpose to continue working to improve the lives of patients through research and integration of these findings into clinical care.”

The 2017 Kappa Delta Ann Doner Vaughn Award was presented to Matthew Dobbs, M.D., for his research on advancing personalized medicine for clubfoot. Dr. Dobbs is the Dr. Asa C. and Mrs. Dorothy W. Jones professor of orthopedic surgery at Washington University in St. Louis. The research was co-authored by Christina Gurnett, M.D., Ph.D., professor Department of Neurology and Division of Pediatric Neurology at Washington University School of Medicine.

Dr. Dobbs commented to OTW, “Winning the Kappa Delta Award is special in the sense that it validates my clubfoot research efforts over the years. It is a true honor to be recognized by my peers as this award is truly considered the ‘Nobel Prize’ of orthopedics.”

We asked Dr. Dobbs about the challenges in developing this algorithm and he told us, “Investigating the etiology of clubfoot while at the same time improving the clinical management of clubfoot posed many challenges. Our research has led to the discovery of the first genes for isolated clubfoot and based on these genetic findings we are developing personalized treatment strategies for patients with clubfoot. This is important as all clubfeet are not the same and therefore different approaches are necessary for better treatment outcomes.”

“We were also able to modify the Ponseti Method of clubfoot casting to successfully treat clubfoot patients with associated neuromuscular disorders as well as older patients who had received no treatment or who were treated previously with surgery. Successful treatment with this minimally invasive approach avoids the need for more extensive surgery and provides better long-term outcomes.”

“Another milestone in our clubfoot research was publishing the negative long-term effects of more extensive surgery on clubfoot patients in terms of foot function and pain. This led to the widespread adoption of the Ponseti Method of clubfoot casting.”

The 2017 OREF Clinical Research Award was presented to Henrik Malchau, M.D., Ph.D., professor of orthopedics at Harvard Medical School and vice chief orthopedics and co-director of the Harris Orthopaedic Laboratory Massachusetts General Hospital in Boston for his research on the impact of arthroplasty implant registries throughout the world. The research was co-authored by Daniel Berry, M.D.; Charles Bragdon, Ph.D.; Göran Garellick, M.D., Ph.D.; William H. Harris, M.D., Sc.D.; Peter Herberts, M.D., Ph.D.; Johan Kärrholm, M.D., Ph.D.; David Lewallen, M.D.; Lars Lidgren, M.D., Ph.D.; and Otto Robertson, M.D., Ph.D.

Dr. Lidgren told OTW, “This award is a recognition of successful research by groups in Sweden and U.S., which I am proud to be part of, publishing 1,800 per reviewed studies over 5 decades with the overall goal to improve the outcome of joint replacements.”

Dr. Berry commented to OTW, “The award is a terrific acknowledgement of the role National and Institutional Joint registries have played over the last 30 years in moving the field of joint replacement forward. During that time joint replacement has moved from a new procedure with much potential to a much more mature procedure with a very high rate of success and reliability. The data provided by Joint Registries has been instrumental to the iterative cycle of improvements that have characterized, and continue to characterize, joint replacement.

When we asked Dr. Berry about his other, related work, he added, “We will continue to use existing Joint Registries to identify the most successful implants and the most successful techniques, and also to identify unexpected problems. Increasingly, joint registries collect comorbidity data and patient reported outcomes and can report these back to stakeholders to allow them to use risk adjusted data to compare outcomes, make modifications in practice where appropriate, and thereby further improve operative outcomes.”

“The United States is now fortunate to have its own national joint registry, the American Joint Replacement Registry (AJRR), which just entered its one millionth joint replacement. As more and more U.S. hospitals and surgeons join the AJRR and enter their data, we will increasingly have a comprehensive system that identifies most successful implants used in North America, identifies best operative and perioperative practices in North America, provides feedback to users, and serves as a trip wire to identify unexpected problems as early as possible when they arise.”

Co-author William Harris, M.D. told OTW, “Clearly, the recognition of all the work of all the authors as well as the inherent recognition of all registry efforts by others is a welcome acceptance of these critical endeavors.”

“However, far more important is the message to the entire orthopedic community of how valuable registry data have been and will be in the progress of total joint surgery. It is only through registry type data that further improvements can be documented, and indeed also further distinction can be made between just change and true progress. All innovative ideas are best evaluated both rapidly and thoroughly, across age groups and disease types as well as across national and cultural differences by grouping big data, i.e., registry data.”

“Our program is deeply committed to assessing both past failures, such as the metal on metal experience, and future possible major advances, such as the ability to deliver antibiotics from polyethylene, pain medicine from polyethylene and further innovative materials and design concepts for total joint surgery.”

In its March 16, 2017 news release, Kappa Delta said, “In 1947, at its golden anniversary, the Kappa Delta Sorority established the Kappa Delta Research Fellowship in Orthopaedics, the first award ever created to honor achievements in the field of orthopedic research. The first annual award, a single stipend of $1,000, was made available to the Academy in 1949 and presented at the AAOS meeting in 1950. The Kappa Delta Awards have been presented by the Academy to persons who have performed research in orthopaedic surgery that is of high significance and impact.”

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Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, August 29th, 2016

Freddie H. Fu, M.D. Inducted Into AOSSM Hall of Fame

The legendary Chair of “Pitt” orthopedics, Freddie H. Fu, M.D., was recently inducted into the American Orthopaedic Society for Sports Medicine's (AOSSM) Hall of Fame during the Society's 2016 Annual Meeting.

Dr. Fu is a Past AOSSM President and the David Silver Professor and Chairman of the Department of Orthopaedic Surgery at the University of Pittsburgh School of Medicine. He holds secondary appointments as Professor of Physical Therapy, Health and Physical Activity, and Mechanical Engineering and serves as the Head Team Physician for the University of Pittsburgh Athletic Department. In 1999, he was awarded an honorary Doctor of Science degree from Point Park University, an honorary Doctor of Public Service degree from Chatham University, and in 2010 was appointed Distinguished Service Professor by the University of Pittsburgh. Dr. Fu received the 2014 Kappa Delta Elizabeth Winston Lanier Award for "Anatomic ACL Reconstruction: A Changing Paradigm" presented by the Kappa Delta Sorority and the Orthopaedic Research and Education Foundation (OREF) and received it at the 2014 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Dr. Fu graduated summa cum laude from Dartmouth College in 1974 and received his BMS in 1975 from Dartmouth Medical School. He earned his medical degree in 1977 from the University of Pittsburgh and completed his general surgery internship at Brown University. He then completed an orthopedic research fellowship—as well as his orthopedic residency—at the University of Pittsburgh. During that time, Dr. Fu was an AO International Fellow at the Hannover Trauma Center in Germany and an arthroscopic surgery fellow in East Lansing, Michigan. In 1984, Dr. Fu was selected as an AOA North American Traveling Fellow. As an ESSKA-AOSSM Sports Medicine Travelling Fellow in 1988, he visited more than 30 sports medicine centers in Europe.

Dr. Fu is a member and has held offices in numerous academic organizations, including the Herodicus Society and the American Orthopaedic Association. He has served as President of the Pennsylvania Orthopaedic Society, AOSSM and the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS).

Elizabeth Hofheinz, M.P.H., M.Ed. • Tue, March 24th, 2015

William D. Bugbee, M.D. Wins Kappa Delta Award

William D. Bugbee, M.D. and his team at the University of California, San Diego have been honored with the prestigious Kappa Delta Award for their 15 years of research on osteochondral allograft (OCA) transplantation. Dr. Bugbee, an Attending Orthopedic Surgeon at the Scripps Clinic and Director of the Adult Reconstruction Fellowship and of the Cartilage Transplant Program, worked with colleagues Andrea Pallante-Kichura, Ph.D., Simon Görtz, M.D., Robert Sah, M.D., Sc.D., and David Amiel, Ph.D.

Dr. Bugbee and his team have done such extensive work on OCA that they have transformed the landscape of the field. He tells OTW, “For many years we have conducted basic science and clinical research on the use of osteochondral allograft for cartilage defects and joint injuries. Fifteen years ago this procedure was rarely used…there were less than 30 cases done in the U.S. in the 1990s. Then in the mid 1990s when cartilage repair became popular we thought that this could be applicable to other situations such as organ transplant. The first thing we looked at was how best to store the tissue recovered from donors. Our work on chondrocyte viability has directly led to an increased supply of fresh OCA and allowed osteochondral allografting to expand outside the universe of specialized university centers. Years later there are a number of tissue banks that can collect, test, and distribute it…and these days there are about 3, 000 of these surgeries done annually in the U.S.”

“Originally, we didn’t have much information on the biology of what happened to transplanted tissue. Then, we developed a goat model, did a transplant and looked at the tissue a year later to study all aspects of bone healing and cartilage repair. We found that preserving chondrocyte viability during graft insertion is critical to the long-term efficacy of the repair.

“Finally, we also evaluated clinical outcomes, something made easier by the fact that we have data on every patient we have ever worked on. We assessed the outcomes of different diagnoses (arthritis, osteonecrosis, osteochondritis dissecans, trauma, traumatic cartilage injury) and looked at things such as patient characteristics, size of graft, etc.

OREF Funding Increases NIH Funding Odds!

Jessica Mehta • Fri, September 8th, 2017

One good thing really does lead to another. According to a study by the Orthopaedic Research and Education Foundation (OREF), published August 17, 2017 in the Journal of Bones and Joint Surgery (JBJS), if a project receives an OREF grant, it has better odds of receiving future National Institute of Health (NIH) funding. “The Relationship Between OREF Grants and Future NIH Funding Success” is authored by Nicholas M. Bernthal, M.D., Vishal Hedge, M.D., Y. Howard, M.D., Stephen Zoller, M.D., as well as Daniel Johansen and Christopher Hamad. All authors are with the Department of Orthopaedic Surgery at the University of California Los Angeles’ David Geffen School of Medicine.

According to Dr. Bernthal, M.D., et al., the team analyzed grants that received OREF funding from 1994 – 2014. Spanning 20 years of funding, these grants included the OREF Career Development Grant (previously the Career Development Award) and the New Investigator Grant (previously the Young Investigator Grant). On average, recipients who received OREF funding went on to receive NIH funding at a 22.3% rate. The average national rate of non-OREF recipients is 18%. Most impressive are the Career Development Grant recipients. They achieve a 46.3% NIH funding rate, which is well above the national average.

According to the authors, “Grants awarded by the OREF are not only important for supporting orthopaedic surgeons during the years they are funded, but also achieve their purpose of identifying and supporting young researchers.” Dr. David G. Lewallen, M.D., OREF president, said, “OREF’s grant review program is modeled on the NIH program, which gives us, as well as our individual and corporate donors, great confidence that the caliber of research and investigator being supported is top-notch.” He commends Dr. Bernthal’s work, and says the findings validate and illustrate the value of research OREF supports.

OREF is a 501(c)3 non-profit organization. Its mission is to improve lives via orthopedic research, leading such research, and eliminating pain while restoring mobility. According to OREF, “extramural research funding has become increasingly difficult to acquire,” which is why one priority of the organization is to support research and create data necessary to secure major funding “from agencies such as the NIH.”

Number Crunching

In total, 126 OREF grants were awarded to 121 people (some were in group projects) since 1994.

Elizabeth Hofheinz, M.P.H., M.Ed. • Fri, May 15th, 2015

Unique Orthopedic Residency Ensuring Doctors Can Communicate

Joseph Zuckerman, M.D. knows how to communicate. Dr. Zuckerman, chair of the Department of Orthopaedic Surgery at NYU Langone Medical Center and a former president of the American Academy of Orthopaedic Surgeons (AAOS), wants to ensure that his residents do too. He tells OTW, “I am proud to say that we are at the forefront of orthopedic resident education, largely because of our Direct Observation and Feedback (DO&F). With the DO&F residents are observed from the beginning to the end of an encounter. Faculty members are trained to observe resident-patient interactions; this incorporates basic communications skills, professionalism, and physical examination. While the DO&F has often been used in medical school, we are the only orthopedic training program using it thus far.”

“We are primarily looking at skills that are related to communication. Our guidelines are the four Es (engagement, empathy, education, patient enlistment) that emanated from the AAOS communications skills workshop developed in 2001. Faculty members provide feedback immediately after a patient encounter, emphasizing what went well and what challenges they faced. The resident is asked to self-assess while the faculty member facilitates the conversation.”

Donna Phillips, M.D. is director of Resident Assessment for the Department of Orthopaedic Surgery at NYU Langone Medical Center. She tells OTW, “The residents have all been taught communications skills in medical school, and they participate in the AAOS communications skills workshop. The DO&F is an educational tool meant to assess what the residents have learned and what skills they can incorporate into patient encounters.”

“We have a checklist for all of the core competencies, focusing on the non-technical competencies. We look for issues of fatigue and professionalism, and overall communications skills. In addition, we assess cost containment, clinical reasoning, and cultural competency. Is the resident dismissive of a patient? Does she treat some patients differently? Is the resident neatly groomed? The trainees self-assess and learning goals are determined. We typically assess each resident four times per year. Thus far we have trained 63 faculty members on how to perform these assessments; as of May 1, 2015 we have performed 245 assessments.”

“Residents usually have the weakest scores on making empathetic statements, responding to patient emotions, assessing understanding, and engaging in shared decision making.

Elizabeth Hofheinz, M.P.H., M.Ed. • Mon, May 11th, 2015

Stuart Weinstein, M.D. Receives OREF Clinical Research Award

For those living with scoliosis, Stuart Weinstein, M.D. has been a godsend. A professor of orthopedics and rehabilitation at the University of Iowa, Dr. Weinstein has now been recognized by the Orthopaedic Research and Education Foundation (OREF) for his decades of work in the field. Dr. Weinstein, who has just been honored with OREF’s Clinical Research Award, tells OTW, “This award recognizes our 40 years of research into scoliosis, and includes information on the natural history of patients with adolescent idiopathic scoliosis (AIS).”

“With this award, OREF also highlights our work on bracing, in particular our efforts to determine if bracing is actually effective. We have been bracing since the 1940s, but it has never been shown to be efficacious. My colleagues and I undertook a multicenter NIH [National Institutes of Health] trial at 25 locations in North America, and we showed that bracing is effective in preventing kids from needing surgery in 90% of cases.”

“When I was a resident, AIS was thought to be a grim prognosis: people would die early, they would not be able to have children, and would become paralyzed. However, the literature that led to those erroneous conclusions was flawed. So this work let parents and doctors know that those with AIS can function well into adulthood and be active older adults; however, if untreated, these patients can experience back pain and significant deformity. Some can even develop pulmonary function symptoms.”

“As for future work, an interesting area of research in AIS is genetics. We know that it is a genetic condition, but we don’t know how it is inherited. The right type of research into this may help us prevent the condition.”

“Scoliosis surgery is extremely expensive, so a major issue is if we can get the same outcomes with fewer implants. My gut reaction is that we can; fortunately, there is a current study that is looking into this.”

“I do think that there is more work to be done on bracing. We need to answer the question, ‘Is there an ideal brace?’ Those 25 centers we worked with used braces of their choice…and no study has yet compared braces.